Document Detail


Effects of different AT1-receptor antagonists in the therapy of severe heart failure pretreated with ACE inhibitors.
MedLine Citation:
PMID:  17824291     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The efficacy of ACE-inhibitors and beta blockers is well documented in the therapy of heart failure. As pharmacological mechanisms of ATI-receptor-antagonists differ, an additional positive effect can be expected when combining these drugs.
METHODS: Eighty patients (67.9 +/- 9.9 years) with severe chronic heart failure receiving long-term medication with diuretics, ACE-inhibitors and partially beta blockers (72.5%), were randomized after clinical recompensation to eprosartan (477.5 +/- 143.7 mg/d), telmisartan (65.9 +/- 17.7 mg), candesartan (11.9 +/- 4.0 mg) or no sartan, according to a prospective study. Haemodynamic measurements by impedance cardiography were performed (mean observation time 15.8 days).
RESULTS: Additional sartan treatment resulted in an improvement of cardiac output from 2.32 +/- 0.69 to 3.12 +/- 1.24 l/min (P = 0.003) in the eprosartan group, from 2.24 +/- 0.59 to 2.76 +/- 0.91 l/min (P = 0.001) in the telmisartan group and from 2.76 +/- 0.84 to 3.11 +/- 0.94 l/min (P = 0.02) in the candesartan group. Furthermore, a significant decrease of the total peripheral resistance was measured under eprosartan (23%; P = 0.002), telmisartan (18%; P = 0.002) and candesartan treatment (11.5%; P = 0.049); in the subgroup of combined therapy with beta blockers, ACE-inhibitors and ATI-antagonists a significant increase in cardiac output was also observed. No change was observed in the control group without additional sartan treatment concerning cardiac output and resistance reduction.
CONCLUSIONS: The additional treatment with different ATI-receptor-antagonists resulted in an increase of the cardiac output and a decrease of the peripheral resistance. This beneficial effect may be due to the additional property of sartans to block the interaction of locally and not-ACE-generated angiotensin II with their vascular and myocardial ATI-receptors.
Authors:
Bernhard Gremmler; Klaus Kisters; Matthias Kunert; Heinrich Schleiting; Ludger J Ulbricht
Publication Detail:
Type:  Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  Acta cardiologica     Volume:  62     ISSN:  0001-5385     ISO Abbreviation:  Acta Cardiol     Publication Date:  2007 Aug 
Date Detail:
Created Date:  2007-09-10     Completed Date:  2008-04-01     Revised Date:  2014-01-09    
Medline Journal Info:
Nlm Unique ID:  0370570     Medline TA:  Acta Cardiol     Country:  Belgium    
Other Details:
Languages:  eng     Pagination:  321-8     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Acrylates / therapeutic use
Adrenergic beta-Antagonists / therapeutic use
Aged
Angiotensin II Type 1 Receptor Blockers / therapeutic use*
Angiotensin-Converting Enzyme Inhibitors / therapeutic use*
Benzimidazoles / therapeutic use
Benzoates / therapeutic use
Biological Markers / blood
Blood Pressure / drug effects
Cardiac Output / drug effects
Chronic Disease
Drug Therapy, Combination
Female
Heart Failure / drug therapy*,  physiopathology*
Heart Rate / drug effects
Humans
Imidazoles / therapeutic use
Male
Middle Aged
Prospective Studies
Severity of Illness Index
Tetrazoles / therapeutic use
Thiophenes / therapeutic use
Treatment Outcome
Vascular Resistance / drug effects
Chemical
Reg. No./Substance:
0/Acrylates; 0/Adrenergic beta-Antagonists; 0/Angiotensin II Type 1 Receptor Blockers; 0/Angiotensin-Converting Enzyme Inhibitors; 0/Benzimidazoles; 0/Benzoates; 0/Biological Markers; 0/Imidazoles; 0/Tetrazoles; 0/Thiophenes; 133040-01-4/eprosartan; S8Q36MD2XX/candesartan; U5SYW473RQ/telmisartan

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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